Non-respiratory signs of worsening asthma in children

Published Online March 4, 2013

National guidelines recommend that children with asthma be treated early in the course of an asthma exacerbation by recognizing early signs of worsening asthma. Parents are often given asthma management plans to guide treatment of their child’s asthma. Some of these plans may include cold symptoms as early signs of worsening asthma, but most parents focus treatment on later signs such as wheezing. Little is known about other early signs of worsening asthma, especially what non-respiratory symptoms such as changes in behavior or appearance may be present before an asthma exacerbation.

A study recently published in The Journal of Allergy and Clinical Immunology: In Practice by Dr. Lisanne Newton and colleagues used a daily monitoring system to determine how early signs and symptoms relate to loss of asthma control. The authors had parents of children with asthma ages 2-11 complete diaries for 16 weeks during cold and flu season that included 41 signs and symptoms that parents had identified as occurring before asthma exacerbations in a previous study. Signs and symptoms that occurred before periods in which the children were at their baseline health were compared to signs and symptoms that occurred before periods in which the children were experiencing loss of asthma control. In addition, parents monitored other markers of uncontrolled asthma, including urgent medical visits and oral steroid use.

Twenty-seven parents were able to complete diaries for the majority of the days (82%). Most children (78%) experienced at least one episode of uncontrolled asthma during the study. Overall, there was a trend for non-respiratory symptoms as a group to be increased in the days prior to uncontrolled asthma. Specific non-respiratory symptoms that were significantly increased were paleness, irritability, anxiety, tension, tiredness, and sleeping problems. Overall, upper respiratory symptoms as a group were not increased in the days prior to uncontrolled asthma. One specific upper respiratory symptom that was significantly increased was an itchy throat.

This study showed that parents can identify early signs and symptoms of worsening asthma and that non-respiratory symptoms may be more commonly present than respiratory symptoms prior to asthma exacerbations. Clinicians should be aware of these non-respiratory symptoms when eliciting early signs of worsening asthma in individual patients, however further investigation is needed to explore whether augmentation of therapy during these signs and symptoms could prevent asthma exacerbations.


The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

AAAAI - American Academy of Allergy Asthma & Immunology